Acupractitioner21 is the sequel to the underground hit Acustudent21, from one of the periods when I was training in Chinese medicine. This blog will focus on Classical Chinese Medicine, CCM, the old system, and on what it´s like to practice acupuncture in the West in the 21st century. The name might have changed, but like everybody in old Chinese medicine, I am still a student.

söndag 6 januari 2013

Classical Chinese Medicine and the body as a living landscape: healing makes our internal landscape heal and flower again, and a look at chapters 12 and 13 of the Neijing and the Classic of Mountains and Seas, Shanghan Lun depths of treatment, Dr Wang Juyi and Jueyin, and how acupuncture must be adapted for the time it is practiced in

What kind of landscape are you?

Are
you a woodland glade, where sunlight shines down in beams of gold,
while birdsong echoes among the trees? Are you a windswept beach,
where you walk along collecting driftwood as gulls laugh on the wind
and the smell of salt fills your nostrils? Are you a quiet Sunday
morning, sitting at home and eating a slow breakfast before
contentedly thinking through the things you are going to do today? Or
are you sitting inside your car, stuck in the middle of traffic,
feeling tense and cramped, with a burning pit of irritation in your
stomach, worry filling your mind, and hands gripping the steering
wheel even harder as you realize you forgot your cell phone at home,
on the kitchen table?..

I think most Westerners know quite
well which of these they would pick to describe their internal
landscape – and which ones they would prefer it to be instead!

In this blogpost we are going to
look at the concept of internal landscape in Classical Chinese
Medicine (CCM). Both the internal landscape in ourselves and in
patients, and on how that internal landscape can be balanced, healed,
and how it can begin to have better harmony with the landscape around
us in our everyday life.

The
concept of internal and external landscape seems to orginally come
from shamanism, and has flowered in a precise system in China within
Daoism. It exists both in CCM and the newer Traditional Chinese
Medicine (TCM). It is stronger in CCM, however, and there is a
greater focus there on shen
(conscious awareness, sometimes translated as ”spirit”) and on
how our shen both creates and lives in our internal landscape. You
can read more about the difference between TCM and CCM in this
previous blogpost:
http://www.acupractitioner21.blogspot.se/2012/08/some-thoughts-on-differences-between.html

Even
the acupuncture points on the body create a living, changing
landscape, something seen clearly in Nanjing,
the Chinese medical classic the Classic
of Difficulties.
An old way of illustrating this very Daoist view can be borrowed from
the Chinese classic the Shanhaijing,
the
Classic of Mountains and Seas.
It was written in the 2nd century BC and is literally a travel-guide
to Chinas holy mountains:

Chapter
3. The first mountain range in the Classic of the Northern Mountains,
part III, is called Mount Grandwalk. Its first peak is called Mount
Goback. There is gold and jade on its summit and green jade on its
lower slopes. There is an animal here which looks like an antelope;
it has four horns, a horse´s tail, and spurs. Its name is the
turner. It is good at wheeling round. When it cries, it calls itself
”hoo-wey.” There is a bird here which looks like a magpie; it has
a white body, a scarlet tail, and six feet. Its name is the ardent.
It is easily frightened. When it sings it calls itself ”Ben”.

This
view has always been part of the very core of Chinese medicine. Many
people are not even aware of their internal landscape at all beyond
that something might feel wrong, that they are uneasy in it or even
really dislike it. Very few people ever get the tools to change it
and let it evolve to something brighter, more verdant, green and
pleasant. Few learn to land in it and relax there, and even just see
what it actually looks like. It is a good exercise to do by yourself,
just like in the intro to this text. What is your internal landscape
like?

”In a similar way, the Chinese think of each person
as a cosmos in miniature. A person manifests the same patterns as
does the painting or the universe. The Yang or Fire aspects of the
body are the dynamic and transforming, while the Yin or Water aspects
are the more yielding and nourishing. One person projects the heat
and quickness of summer Fire; another person resembles the quiescence
and coolness of winter Cold; a third replicates heaviness and
moistness of Dampness; a fourth has the shrivelled appearance of a
dry Chinese autumn; and many people display some aspects of the
various seasons simultaneously. Harmony and health are the balanced
interplay of these tendencies.

In each person, as in every landscape, there are
signs that when balanced, define health or beauty. If the signs are
out of balance, the person is ill or the painting is ugly. So the
Chinese physician looks at a patient the way a painter looks at a
landscape – as a particular arrangement of signs in which the
essence of the whole can be seen. The body´s signs, of course, are
somewhat different from nature´s signs – including color of face,
expression of emotions, sensations of comfort or pain, quality of
pulse – but they express the essence of the bodily landscape.”

Daoism and Chinese medicine: the Daoist view of
internal landscape infusing the Chinese medical one

Daoism, the ancient Chinese spiritual tradition, has
given this view and its framework to Chinese medicine. We will look
further at examples from the pure Daoists texts a bit later on in
this text, but it is interesting to see how much it has shaped
Chinese medicine, something visible all through the classical chinese
medical texts. Here a quote from Kristofer Schipper, one of the few
researchers in the West who actually spent years studying in Taiwan
to become a daoshi, a
daoist priest, in order to more deeply understand the tradition.

””The human body is the image of a country,”
say the Taoists. There they see mountains and rivers, ponds, forests,
paths, and barriers, a whole landscape laid out with dwellings,
palaces, towers, walls, and gates sheltering a vast population. It is
a civilized state, administered by lords and their ministers.

The vision of the human body belongs both to Taoism
and to Chinese medicine. The fundamental work of medical theory, the
Simple Questions of the Yellow Emperor, describes the body thus: ”The
heart functions as the emperor and governs through the shen (”soul”);
the lungs are liaison officers who promulgate rules and regulations;
the liver is a general and devises strategies.”

– The Taoist Body,
Kristofer Schipper, UCP 1993

Chinese medicine is full of these
maps making our internal landscape alive with characters and faces we
can have good or bad relationships with, depending on how our shen
works inside us:

”The
Yellow Emperor asked: All methods of needling must first have their
basis in spirit. The blood, the vessels, the construtive qi, essence,
and the spirit are all stored within the five viscera. Therefore,
what are vitality (de),
qi,
life (sheng),
essence, spirit, hun,
po,
the heart-mind (xin),
reflection (yi),
will (zhi),
thought (si),
wisdom (zhi)
and worry (lu)?
Please tell me about these.”

And the Chinese medical, and
Japanese medical, traditions that involve channel palpation –
feeling and mapping the changes of the meridians, and how they
reflect the balance in our internal landscape – have an even more
physical and alive, felt sense, of the body and the shen that
inhabits it.

”Lei
Gong asked: it is stated in the Jinmai that, with respect to
needling, a knowledge of the channels and vessels is of foremost
importance. Please tell me why this is so.”

A two-part article and interview on Dr Wang Juyi and his system will
appear in the UK Tai Chi Chuan Magazine beginning February 2013.)

One of my favourite quotes from Dr
Wang, from his book, talks beautifully about an acupuncturist´s own
relationship with the points he uses to help the patient become
healthier – basically a quote of the microcosm instead of The
Classic of Mountains and Seas macrocosm.

In Daoist texts there are often
even further details in the internal landscape, which in the
traditions is part of practical training-techniques done for decades,
but they are also usually written in code to prevent outsiders from
gaining access to the material or hurting themselves by trying to
train it without the prerequisite knowledge and a good teacher. This
quote from a text from one of the main schools of Religious Daoism,
the Quanzhenpai, talks about the energy center known as the
Lower Dantian in the West, and offers a long list of alternative
names for it.

”1.3
cun (about 3cm) inside the navel is where the primal yang Real qi is
stored. The
area inside the navel alone within the body is called the Central
Palace, the Mansion of Life, the Spiritual Room of Primordial Chaos,
the Yellow Court, the Elixir Field, the Cavity of Spirit and Qi, the
Orifice for Returning to One´s Roots, the Passage for Restoring
One´s Life, the Orifice of Primordial Chaos, the Cavity of 100
Meetings, the Gate of Life, the Spiritual Hearth of the Great One
(Taiyi;
the North Pole Star), the Original Visage. It has many different
names. This place encloses the most exquisite q, which penetrates the
100 blood vessels and nourishes the entire body.”

Neijing chapters 12 and 13 and the teachings of
changing treatments with place and time

The Neijing – Huangdi Neijing
– is the core text of Chinese medicine. It contains huge amounts of
information, some of it obvious, some of it hidden and taught only
through a trained teacher in an apprentice setting.

The pressure from the outside world on our internal
landscape of course changes depending on our surroundings and the
time and place we live in. Daoism would factor all this into their
studies of bianhua,
change, and how it affects us and how we can learn to move more
smoothly and freely with it. In Chinese medicine, this should be a
deep field of study for the practitioner: how does change in place
and time affect the patient, and how can it be treated well?

This is part of chapter 1 of the Neijing and then a
recurring theme all throughout.

Two of the chapters that illustrate it further is
chapter 12 and 13 of the Neijing; chapter 12, goes through examples
of how treatments have to change depending on where people live in
the different directions of the compass:

”In the Northern district of mostly highland,
where the weather is cold, shutting and hiding like winter, the
people there live in the mountains and hills and the cold wind often
sweeps the frozen land. The local people like to stay in the
wilderness to drink the milk of cows and sheep. In this case, their
viscera can easily contract cold and the disease of abdominal
distension. In treating the disease, moxibustion therapy should be
used, thus the moxibustion therapy is transmitted from the North.”

Through this and other
examples, the text teaches the idea of adapting treatments depending
on the external surroundings of the patient.

Chapter 13 of the Neijing deepens this further into how
we must adapt treatments after the time
the patient lives in.

The Neijing is a teaching-text built in the same way
as a classical apprenticeship in Chinese medicine, with questions
from student to teacher, in the text represented by the legendary
Yellow Emperor and his adviser Qi Bo. First Qi Bo describes how
people in ancient times moved much more with the seasons, kept their
hearts pure and didn´t allow their ambitions and hunger to control
them. Then he describes the problems people have ”now” and how
badly it has gone with people´s health since ancient times. (It´s
worth remembering that the text was written about 2200-2300 years
ago...)

”But the case nowadays is different, people are
often affected by anxiety in the heart, and hurt by the toil on the
body on the outside, and people are careless and no longer care to
follow the natural change of the seasons, nor the coldness and heat
of the day. When external influences invade the system, the patient´s
viscera and bone marrow will be hurt inside, and the orifices and
muscle will be hurt on the outside. If the disease contracted is
mild, it will become a serious one; if it is serious, it will surely
end in death. Therefore, the disease nowadays cannot be treated
simply through nourishing the essence or changing the qi like it used
to be.”

– Neijing,
Wu and Wu,
ibid

Chapter 13 then goes on to list examples of how
acupuncture doctors in older times were much more precise and careful
in their diagnosis and their skill in seeing the shen, the
”spirit” (mind and conscious awareness) of the patient. Often
this is translated only as ”complexion”, but it actually means
really becoming aware of shen and learning the skill of seeing –
feeling, being aware of – its health in both ourselves and in a
patient.

”In ancient times,” continues Qi Bo to his
student, the Yellow Emperor, ”there was a physician whose name
was Daiji. He studied the principle of seeing shen
and feeling pulse to the degree of making it a heavenly skill; he
could connect them to the Five Elements of Metal, Water, Wood, Fire
and Earth, the five seasons, Yin and Yang, evil winds of all
directions and the three dimensions, not divorcing them from the
principle of their mutual change. So, it is important for one to
observe the shen and pulse conditions to know the essentials of the
disease.”

–
Neijing, Wu and
Wu, ibid

Here we see Qi Bo talking about a very skilled
practitioner of Classical Chinese Medicine indeed. The example he
extols has trained so deeply himself, and studied diagnostics so
well, that he can factor in both the shen of the patient, the pulse,
the Five Elements in the patient as well as the Five Elements in the
season at the time; Yin and Yang in the patient, the liuxie,
the ”six external pathogens” as they are currently translated
now, but originally the ”six evils” that affect us from the
outside (wind, cold, dampness, dryness, summer heat, fire) and,
again, from Chapter 12, the three dimensions, that is the place the
patient lives in – and all this, this doctor can analyze from a
deep understanding of the bianhua and
how it manifests in Chinese medicine, the change that weaves
them all together, and make a good diagnosis and treatment that will
unfold in the patient and balance their health. This level of skill
takes very deep training and continous research for a practitioner to
reach. They first have to become very aware of all these in
themselves and study them there, before being able to fully
understand how it can affect the patient sitting in front of them.
This is one reason that the Daoists who also worked as acupuncture
doctors used qigong- and meditation-practice so much themselves.

We are going to look more into a specific affect of
time further on in this text, with Dr Wang Juyi´s comment about
Jueyin, the deepest yin in our system, and how living in our
time affects it.

Geography in depth in the body: levels of depth in
acupuncture treatment and in the Shanghan Lun

Another part of our internal landscape is the
manifestation of it in physical depth in our body. Daoist practices
teach that the deeper in our system we feel, the deeper levels of our
emotions, mind and psyche we also activate and access, which is the
reason that any qigong- or meditation-practices working on this
should be taught in quite careful stages over a very long time.
Speeding that process up usually creates an unstable system within
the practitioner, which is one of many reasons to look for a skilled
teacher one can have long-time contact with.

In Chinese medicine, there is something called the Six
Levels. They are written about in the Neijing, but really reach an
apex in the Chinese medical classic called the Shanghan Lun, the
Classic of Febrile Disease caused by Cold. The
Shanghan Lun was written in the 200´s by legendary doctor Zhang
Zhongjing. The Six Levels themselves give a geography in depth of the
body and mind of a patient and of the practitioner: each level is
linked to two meridian systems at that depth, and their corresponding
organs and emotions, and the way they help our internal landscape
interact with our external one.

The first one is
Taiyang, Ultimate
Yang, which covers the huge area of the entire back of our body and
the meridians of the Bladder and Small Intestine and their respective
organs, functions, and links to our emotions and mind. Then it
continues deeper by stages, all the way to Jueyin,
Ultimate Yin, deepest yin, the deepest levels of blood and stillness
and healing in us, which are linked to the Liver and Pericardium.

The Shanghan Lun is the root of what is now one of the
main herbal traditions of Chinese medicine, since the book is
primarily focused on herbal medicine in a specific form. Zhang
Zhongjing wrote down diagnostics and treatments not only for each
level, but also very detailed for how far it has moved in that level
itself.

”Clause 1-4: During the first day of febrile
disease caused by Cold, the syndrome is at the Taiyang Channel. If
the pulse is quiet, the syndrome is not transmitting into the next
channel. When the patient is restless and nauseated, and the pulse is
speedy and mighty, then the syndrome is transmitting.”

The Shanghan Lun was later split up, and what became the
second book is called the Jingguyi Yaolue, Synopsis of
Prescriptions of the Golden Chamber,
often less studied than what is known as the Shanghan Lun today. In
the video below, Dr Arnaud Versluys also adds that the Shanghan Lun
was meant to begin with external factors affecting us, and the second
part of the book, before they got separated, was intended to cover
internal conditions that affect us, thus giving a complete overview.

”One should carefully protect one´s Body
Resistance and avoid the attack of climatic pathogenic factors.
Otherwise, channels and collaterals will be violated and health
endangered. In case pathogenic factors have invaded the channels and
collaterals, medical treatment should be given in time to stop the
transmission of pathogenic factors into the viscera and bowels.”

For those of you interested in learning a little bit
more about Zhang´s views and his tradition, I can recommend watching
this video of Arnaud Versluys, one of the most famous exponents of
the Shanghan Lun tradition in the West in our time. In this video he
describes the historical background around the Shanghan Lun and helps
give a basic view of how it thinks.

The Six Levels help us understand how problems and
illnesses can begin at different levels in us, and how they can
progress to become worse the deeper they go. For a practitioner, it
should help us understand how to find out what level the patient´s
problem is, and how to treat that and gently allow the system to open
up instead of trying to attack deeply into it to fix ”the problem”
we perceive being there. (You can read a blogpost about why awareness is so important in acupuncture and Chinese medicine diagnostics here: http://acupractitioner21.blogspot.se/2011/05/chinese-medicine-and-awareness-demand.html)

Dr Wang Juyi and Jueyin, the deepest yin in our
system, and how our time affects it

”The character for Jue has an interesting
construction. The outside of this character comes from the obsolete
character han, a
partial enclosure that means cliff, as on the side of a mountain. The
inside of the character is a variant of the commonly used que,
which usually means lacking, but can also mean vacant or an opening.
The character jue therefore suggests an opening or vacancy on the
side of a mountain. It is a place of absolute stillness and retreat
from which one begins the process of ”reverting” back to Yang.
Recall the Daoist influence on Chinese medicine, and it is not
difficult to imagine the adepts of a thousand years past retreating
into their caves in the mountains. This is a helpful image for jue
yin, but is at odds, in some respects, with a commonly held
belief by many modern practitioners who think of jue yin as a moving
cauldron of emotions. Of course, for many modern patients, the cave
of retreat may in fact be filled with just such chaos! In such cases,
yin and blood will not have a place for restoration.”

– Robertson and
Wang, ibid.

Jueyin is the deepest level of the primary meridian
system, the deepest of the Six Levels, the place for deepest yin,
stillness and healing. Or should be. Like Dr Wang says, in our time,
that is very rarely the case. For many Westerners, that cave of
stillness and healing in us has become a McDonald´s restaurant on
Sunday lunch, with added disco-ball above and loud cell-phone
conversation in our ear on a phone that keeps beeping with new texts
at the same time.

This can be changed to the better.

It is fully possible to begin a healing process and
change this to become calmer, healthier, more quiet, and a place more
of healing again. Simple meditation-practices help with this, of
course, but a good acupuncturist will be able to help you begin and
stabilize that process a lot. It is often easier to do with the help
from someone on the outside, in the beginning. You can read more
about what healing can mean, and how we get a framework for
understanding it, in this blogpost:
http://acupractitioner21.blogspot.se/2012/04/acupuncture-and-how-we-can-heal-healing.html

And speaking of that cliffside enclosure, that
hermitage, that deep still place, here is a poem from a Daoist
tradition, the Quanzhenpai, one of the main schools of
Religious Daoism in China today. It helps give a feeling of that
stillness, but it´s also interesting since the author, Ma Yu, is
more known as a legendary Chinese doctor under his name Ma Danyang
and for his sequence of acupuncture points, Ma Danyang´s Star
Points. Ma was the first generation disciple to Wang Zhe (”Lunatic
Wang”), who founded the Quanzhen school.

Living in the Hut

Even though I have no fire in the
winter, I embrace the primal yang.

In summer I cut myself off from
the clear spring water, but I drink the jade juice.Wax candles I do not burn, but I
make bright the candle of my Nature.Garoo wood incense I have no use
for, since I can burn my heart´s incense .

Three years barefoot, my vow of
three years.

My one aspiration is toward the
blue skies, and this one aspiration grows.The mountain fool who keeps
mourning is in his hut.He still has done nothing to repay
the Lunatic Wang.

– Ma
Yu (Ma Danyang), Eskildsen, ibid.

Summing up: our internal
landscape and beliefs, how we believe it ”is” or ”must” be

What kind of landscape do you want
to be?

Is the landscape inside you
something you are comfortable with? Something you like and can relax
into?

If we want, we can change it.
Many people have a belief that their internal landscape cannot be
changed, cannot heal, cannot become more whole again. But it is fully
possible to do this, and to feel so much happier with who we are inside.

In China, the saying is yi bu
yi bu lai, one step at a time will get you there. Whatever we
want to change, we begin where we are right now. It is a huge thing
to want to change to the better: after that, we simply take one step
at a time to change our internal landscape into something more alive, relaxed,
green, filled with flowers, sunlight, moonlight, and the stars of
clear summer nights.